THE PRESENT USE OF THE UCBL FOOT ORTHOSIS

M i c h a e l J . Q u i g l e y , C . P . O . 1

In A u g u s t 1 9 7 1 , t h e C o m m i t t e e o n P r o s t h e t i c s R e s e a r c h a n d D e v e l o p m e n t ( C P R D ) of t h e N a ­t i o n a l R e s e a r c h C o u n c i l c o m p l e t e d a n e v a l u a t i o n o f f o u r l o w e r - l i m b o r t h o s e s . T h e y w e r e t h e V A P C S i n g l e - B a r K n e e - A n k l e - F o o t O r t h o s i s ( K A F O ) . t h e U C B L D u a l A x i s A n k l e - F o o t O r ­t h o s i s ( A F O ) , t h e N e w Y o r k U n i v e r s i t y i n s e r t A n k l e - F o o t O r t h o s i s , a n d t h e U C B L S h o e I n s e r t F o o t O r t h o s i s ( F O ) ( F i g s . 1 a n d 2 ) . T h e l a t t e r t w o o r t h o s e s w e r e c o n s i d e r e d t o b e v a l u a b l e a d d i ­t i o n s t o p a t i e n t s e r v i c e s , a n d it w a s r e c o m ­m e n d e d t h a t t h e y b e i n c l u d e d in o r t h o t i c s e d u c a ­t ion p r o g r a m s (2 ) .

T o d e t e r m i n e t h e a c c e p t a n c e o f t h e U C B L s h o e i n s e r t foo t o r t h o s i s , h o w t h e t e c h n i q u e w a s l e a r n e d , a n d s o m e t h i n g a b o u t t h e e x p e r i e n c e s in t h e f i e l d , a l i m i t e d s u r v e y w a s c o n d u c t e d . T h i r t y - f i v e c e r t i f i e d o r t h o t i c s a n d p r o s t h e t i c s -o r t h o t i c s fac i l i t i es w e r e s e l e c t e d r a n d o m l y f r o m t h e 1974 Registry of Accredited Facilities (1). T h i s r e p r e s e n t e d a n e q u a l d i s t r i b u t i o n o f p r a c ­t i t i o n e r s f r o m t w e n t y c i t i e s . T h e q u e s t i o n n a i r e s ( A p p e n d i x A ) c o n s i s t e d o f a s e c t i o n t o b e c o m ­p l e t e d by t h e p h y s i c i a n a n d a s e c t i o n to b e c o m ­p l e t e d by t h e o r t h o t i s t . T h e o r t h o t i s t w a s r e ­q u e s t e d t o f o r w a r d t h e q u e s t i o n n a i r e t o t h e p h y s i c i a n a f t e r h i s s e c t i o n w a s c o m p l e t e d . T h e q u e s t i o n n a i r e s w e r e s e n t o u t in J a n u a r y 1974. B y M a r c h 1974. t w e n t y - n i n e o f t h e f o r m s w e r e r e -

1Staff Prosthet is t /Orthot is t . Commit tee on Prosthet­ics Research and Deve lopment . National Academy of Sc iences , Washington, D. C. 20418.

Fig. 1. The U C B L foot or thos is .

Fig. 2. Principles of the U C B L foot or thosis applied to the foot section of a polypropylene ankle-foot or thos is .

turned. The following information was taken from these forms.

The U C B L foot orthosis was used by 75 per­cent [21]of the surveyed practi t ioners. However , only seven of the twenty-one practit ioners w h o use this orthosis do so regularly. Of the remaining fourteen respondents , five use the orthosis only when it is requested by a certain physician, five rarely use it, two use it for special condit ions only, and one stated he uses the orthosis only as a last resort .

An at tempt was made to determine how the practi t ioners were made aware of the UCBL foot or thosis . The literature rated as the most com­mon source of informat ion . Ar t ic les on the U C B L foot orthosis appeared in the Bulletin of Prosthetics Research (3) in September 1969 and in Orthotics and Prosthetics (4)in March 1972. In addi t ion . N e w York Univers i ty published an evaluation report (5) on the orthosis in 1969. The prosthet ics-orthotics educat ion courses were the second most common source of information on the subject. Word of mouth rated as the third main channel of communicat ions , since some re­spondents stated that or thot is ts , podiatr is ts , e t c . , had informed them of the technique.

P R E S C R I P T I O N C O N S I D E R A T I O N

Eight areas considered to influence the pre­scription and use of the U C B L foot orthosis were covered in the quest ionnaire . The most common prescription was bilateral or thoses for a patient 25-40 years old with pes planus.

The pathologies most commonly t reated with the U C B L foot orthosis are pes planus and ar­thritis. Following these , in order of frequency, are plantar fasciitis, metatarsalgia, polio, cere­bral palsy and peroneal palsy.

Respondents indicated that the orthosis is used equally on males and females and is fitted bilater­ally the vast majority of the time. The age groups that use the U C B L foot orthosis most often are between 1-12 years of age and be tween 25-40 years of age.

The major disadvantage of using this orthosis is the expense , a fact that was underscored by half of the r e sponden t s . The o the r d i sadvantages checked off by the practi t ioners are that a wider shoe is somet imes needed, that the orthosis slips up and down in the shoe, and that breakage oc­curs . Two practi t ioners felt the orthosis is dif­ficult to fit.

The major advantages of using this orthosis is that is provides proper foot support , allows the patient to change shoes , eliminates shoe modifi­cat ions and the need for or thopedic shoes . The practi t ioners also felt that the U C B L foot or­thosis provides improved cosmesis and gives consis tent relief from pain.

Most of the respondents indicated that the or­thosis usually lasts longer than a year before re­placement is necessary , although a few prac­titioners stated that it only lasts up to one year . The major reason that the U C B L foot orthosis needs rep lacement is a loss of fit with t ime. Breakage is the second most common reason re­placement was needed. One practi t ioner stated that he replaces the or thoses in cases when he wants to increase progressively the amount of foot correct ion.

C A S T I N G , F A B R I C A T I O N A N D F I T T I N G

This part of the survey was structured to de­termine if the original technique is still practiced, what materials and methods are presently used for fabrication, fitting problems encountered and solutions to these problems.

Nearly every practi t ioner stated that he uses the same method of wrapping to obtain the mold as was descr ibed originally in the l i tera ture . Manual alignment of the foot and ankle is prac­ticed by all r espondents , as is the use of the contoured casting boards for positioning the pa­tient. One-quar ter of the orthotists use s tandard plaster bandage rather than the elastic type origi­nally r ecommended , and one-third of the or­thotists no longer use the balloon method for casting.

Polyester resin is used exclusively by eight of the or thot is ts , four use both polyester resin and polypropylene , five use polypropylene exclu­sively, one uses polyethylene and one uses acryl­ic.

It is interesting that of the seven practi t ioners that had breakage problems, six use polyester resin for fabrication and one uses polyethylene. None of the orthotists that utilize polypropylene exclusively mentioned breakage problems.

The most common fitting problem is pain at the location of the navicular (scaphoid) bone , which is located medially at the apex of the arch of the foot. Shoes being too tight when the orthosis is worn is the next most common problem, followed by pistoning of the foot in the shoe , and difficul-

ties in establishing the trimline at the metatarsal area. One pract i t ioner stated that he has his pa­tients acquire a pair of shoes that will accommo­date the or thosis .

None of the orthotis ts do any shoe modifica­tions in addition to using the U C B L foot or thosis .

Six orthotis ts consistently modify the foot or­thosis . Wedges and metatarsal relief pads are added by two pract i t ioners . One orthotis t uses Spenco* bui ldups, presumably for better weight d is t r ibut ion and reduc t ion of shea r s t r e s se s . Another adds a Velcro s t rap over the dorsum of the foot to prevent the foot from pistoning. To decrease the sliding of the foot or thosis on the insole of the shoe , one or thot is t lines the bot tom surface of the orthosis with moleskin or thin non-skid rubber .

D I S C U S S I O N

The U C B L foot orthosis was first publicized in September 1969, and introduced in the educat ion programs in late 1971. The fact that 75 percent of the surveyed practi t ioners had used the orthosis by January 1974 is a tes t imony to the speed that proven research in this field is applied to the

patient. Probably no o ther medical or paramedi­cal specialty can realize these patient benefits from research only four and one-half years after the initial introduction of a technique.

The utilization of this or thosis may decrease in the fu ture as t h e r m o p l a s t i c , t h e r m o f o r m e d lower-limb or thoses gain accep tance . However , the U C B L foot alignment principles still apply to

, the foot section of thermoplast ic ankle-foot o r tho­ses and knee-ankle-foot o r thoses , and should be used whenever possible.

R E F E R E N C E S

1. American Board for Certification in Orthotics & Prosthetics, Inc., 1974 Registry of Accredited Facilities and Certified Individuals in Orthotics and Prosthetics, Washington, D.C., 1974.

2. Committee on Prosthetics Research and De­velopment, A Clinical Evaluation of Four Lower-Limb Orthoses, National Academy of Sciences, Washington, D.C., 1971.

3. Henderson, W . H . , and J. W. Campbell, UC-BL shoe insert: casting and fabrication. Bull. Pros. Res. 10-11:215-235, Spring 1969.

4. LeBlanc, Maurice A., Aclinical evaluation offour lower-limb orthoses. Orth. and Pros. 26:1:27-47, March 1972.

5. Mereday, C., C.M.E. Dolan, and R. Lusskin, Evaluation of the UCBL Shoe Insert in "Flexible" Pes Planus. New York University, September 1969.

*A foam rubber that is impregnated with nitrogen bubbles.

APPENDIX A

C O M M I T T E E O N P R O S T H E T I C S R E S E A R C H A N D D E V E L O P M E N T D I V I S I O N O F M E D I C A L S C I E N C E S — N A T I O N A L R E S E A R C H C O U N C I L